For Cancer, Chemotherapy's Complementary Medicine Is Social Interaction

Even with cancer survival rates notably improving during the last few years, cancer is still one of the leading causes of death in the United States and internationally. Finding a way to cure, combat, and prevent cancer is one of the top priorities for researchers, scientists, and medical professionals. Many efforts are being put into bettering chemotherapy, but one recent discovery might not have been so expected. Researchers found that social interaction is capable of increasing a person's chance of survival after they have started cancer treatment. To read their full findings, their work has been published in the journal Network Science.

The Study

Researchers from the National Human Genome Research Institute (NHGRI), in collaboration with the University of Oxford in the United Kingdom, found a gap in information regarding social interaction, and its effect on those with cancer. Being that such little data was available, they set out to test the influence of social interaction on the effectiveness of common cancer therapies, especially chemotherapy - being that it is the most common cancer therapy. They were seeking data on how survival rates would be altered when chemotherapy was combined with social interaction.

Leading the study was NHGRI's Social and Behavioral Research Branch's Jeff Lienert, who was also the first author. Leinert's team consisted of his adviser Felix Reed-Tsochas, Ph.D., at Oxford's CABDyN Complexity Centre at the Saïd Business School, Laura Koehly, Ph.D., chief of NHGRI's Social and Behavioral Research Branch, and Christopher Marcum, Ph.D., who is a staff scientist also in the Social and Behavioral Research Branch at NHGRI.

They tested whether the 5-years chances of survival of patients were altered when they were interacting with others who were also undergoing chemotherapy and surviving. In order to make this assessment, the researchers accessed the electronic medical records from 2000 to 2009 belonging to 4,691 patients who were in the process of chemotherapy treatment at various medical facilities in Oxfordshire, United Kingdom belonging to the National Health Service.

The average age of these patients was about 60 years old. 44 percent of the patients studied were male, in an attempt to keep the distribution of male and female patients approximately even. What the researchers sought to do was to investigate "co-presence in a chemotherapy ward." In order to do so, they generated a network of patients capable of co-inhabiting in such a ward.

The researchers first analyzed how much time, in total, patients spend in each other's company. In order to assess how social influence plays a role on patient's 5-year mortality rates, scientists weighted the co-presence of "immediate neighbors."

Lienert explained his procedure in the study further, by explaining, "we had information on when patients checked in and out of the chemotherapy ward, a small intimate space where people could see and interact for a long period of time. We used 'time spent in chemotherapy in a room with others' as a proxy for social connection." While it may not be the most conventional form of social interaction, Lienert's findings depict that it does create a significant change in these patients.

Results

Lienert and his team successfully found that patients spending time with other patients who have survived their cancer for at least five years after completing chemotherapy, or other common cancer treatments, led to an increased survival rate for the patient in their company. For the patient in the company of one who is living past the 5-year mark, their own odds of dying drop to approximately 68 percent. However, for patients who do not survive for at least five years, or are very unlikely to be able to do so, the patients in their company are less likely to survive. In this scenario, the patient in the company of one who is likely to die in under five year's chances of dying within the first five years of beginning chemotherapy lift to 72 percent. While both of these outcomes may seem relatively grim, as there is a positive chance of dying either way, they do depict a marked social interaction influence on survival rates.

Lienert explains their findings by pointing out, "people model behavior based on what's around them. For example, you will often eat more when you're dining with friends, even if you can't see what they're eating. When you're bicycling, you will often perform better when you're cycling with others, regardless of their performance." Put into this perspective, it is no wonder that the effect of others' presence would have a significant impact on survival rates, as interaction somewhat subconsciously changes our own habits and how we act or perform.

Of course, there is also the possibility that a patient will remain in isolation, instead of having social interaction like the aforementioned patients did. The scientists compared their findings to conclude that social interaction, as a whole, can account for a 2 percent increase in survival odds.

How significant is 2 percent?

Many may dismiss the scientists' findings due to 2 percent appearing measly, but Lienert explains that their findings were actually very significant. He says, "a 2 percent difference in survival - between being isolated during treatment and being with other patients - might not sound like a lot, but it's pretty substantial [...] If you saw 5,000 patients in 9 years, that 2 percent improvement would affect 100 people."

Why this increase in survival rate?

Unfortunately, the scientists are not yet able to explain causality, despite the study being observational. However, they speculate that social interactions relieve stress, and that stress has a large part in determining survival rate. Of course, in true camaraderie, if your friend is ill you will worry or stress about them, like yourself - leading to alleviated stress when they are better or heightened stress when they are not doing well, explaining the change in results based on the other patient's survival likelihood. Lienert hypothesizes that when stress hormones build up to an excessive extent, there is a possibility that one's chances of survival may lower, therefore creating a need for stress-relievers like social interactions.

How to put this study into practice

Laura Koehly explains why this research has been so important, "Mr. Lienert's research is the first to investigate, on a large scale, how social context in a treatment setting can play a significant role in disease outcomes. As cancer care moves more towards targeted therapies based on genomic tumor assessments, NHGRI is interested in understanding how these social environmental factors might impact treatment efficacy."

Lienert wants this study to mean more than just a hypothetical survival rate - but a call to those who know people with cancer to step up to help them. He explains that providing social support for those undergoing chemotherapy is integral and would compare with the findings of his own study, saying, "positive social support during the exact moments of greatest stress is crucial. If you have a friend with cancer, keeping him or her company during chemotherapy probably will help reduce their stress. The impact is likely to be as effective, and possibly more effective, than cancer patients interacting with other cancer patients."

The results of this study address an aspect of care that is often pushed aside in the highly scientific field of treatment - that of care. Lienert and his team successfully put scientific data to what is often a complex "grey area" - that something as simple as caring for others and interacting can truly save lives.

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